Fitness Center Personal Profile

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Fitness Center Personal Profile

Completion of the following Health and Exercise Profile is necessary before participating in a regular exercise program at Carl Sandburg College. The following information is confidential and will not be revealed to anyone outside the Fitness Center staff without your written consent. The information may be compiled into a data base to be used to report statistical data.

Personal Information

First Name *

Last Name *

Student ID *

Gender *

Male

Female

Contact Person in case of emergency

Contact emergency phone

Please list any medications

Questionnaire

Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active.

If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below. If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you start. If you are over 69 years of age, and you are not used to being very active, check with your doctor.

Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly: check YES or NO.

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?

Yes

No

Do you feel pain in your chest when you do physical activity?

Yes

No

In the past month, have you had chest pain when you were not doing physical activity?

Yes

No

Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity?

Do you know of any other reason why you should not do physical activity?

Yes

No

Talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES.

You may be able to do any activity you want — as long as you start slowly and build up gradually. Or, you may need to restrict your activities to those which are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice.

Find out which community programs are safe and helpful for you.

If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can:

start becoming much more physically active – begin slowly and build up gradually. This is the safest and easiest way to go.

take part in a fitness appraisal – this is an excellent way to determine your basic fitness so that you can plan the best way for you to live actively. It is also highly recommended that you have your blood pressure evaluated. If your reading is over 144/94, talk with your doctor before you start becoming much more physically active.

By clicking submit you agree to "I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction."